What pathology is
Your doctor or health professional may request specific pathology tests to help them understand, diagnose and treat a health issue you are having to be able to determine the appropriate treatment.
Specially trained staff perform these tests in accredited pathology laboratories. They collect samples from you, such as blood, urine, saliva or faeces.
Learn more about pathology tests on:
Why it is important
Pathology tests provide information on many types of health conditions, including:
- allergies
- chronic conditions, such as diabetes
- infections, including COVID-19 and other diseases
- different types of cancer.
Test results give your doctor or health professional the information they need to:
- diagnose your health issue
- manage your condition.
The pathology process
When your doctor decides you need a pathology test they will fill in a pathology request form. These can be either paper copy or electronic.
Pathology collection centre staff usually take the samples, but in some cases your doctor or their practice staff can also do this. Make sure you follow any instructions, such as fasting before the test.
Trained staff test the samples at an accredited pathology laboratory and provide the test results to the requesting doctor or health professional.
Once your test results are available, your doctor may need you to make an appointment so they can:
- discuss the test results with you
- organise any follow-up tests you may need.
You can ask that your results are added to your My Health Record. Learn more on the My Health Record website.
Cost of pathology
Medicare subsidises the costs of pathology services listed in the Medicare Benefits Schedule (MBS). If patients wish to claim Medicare benefits for services, the laboratory must be an accredited pathology laboratory.
Medicare benefits are only payable for pathology services if:
- clinically relevant and requested by a doctor or health professional
- if provided by or on behalf of an approved pathology practitioner, in a relevant accredited pathology laboratory that is operated by an approved pathology authority.
A list of pathology tests on the Medicare Benefits Schedule can be accessed from MBSonline. It’s a good idea to ask your doctor about any costs that Medicare may not cover before you arrange to have the test. Some tests have conditions, such as limits on how many you can have in a year.
If your doctor requests a test be done more than once on the same day, Medicare will only cover the first test (rule 3). To overcome this, your doctor must request a ‘rule 3 exemption’ on your pathology request form.
Who can provide pathology services
Only accredited pathology laboratories can provide pathology services. In order to be accredited, a pathology laboratory must meet specified quality standards.
Learn more about the pathology accreditation process.
You can choose your own pathology provider, regardless of which provider has supplied the pathology request form your doctor uses. The exception to this is when your doctor has asked that a specific pathology provider do the tests. They may do this for clinical reasons.
All branded pathology request forms – whether they are paper copy or electronic – must include a patient choice advisory statement that outlines this.
Learn more about pathology services for health professionals on Services Australia’s website.
Pathology laws and regulations
National legislation that regulates pathology services provided under Medicare includes the:
- Health Insurance Act 1973
- Health Insurance Regulations 2018
- Health Insurance (Pathology Services Table) Regulations 2020
- Health Insurance (Pathology) (Fees) Act 1991
- Health Insurance (Approved Pathology Specimen Collection Centres) Tax Act 2000
- Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2017
- Health Insurance (Approvals for Eligible Collection Centres) Principles 2020.